Introduction Epistaxis is a common complaint in the emergency department (ED) 1. About 60% of population experience epistaxis at least once during their lifetime and 6% needs medical attention 2. The cause of epistaxis is unknown in majority of cases. Known etiologic factors can be divided into local and systemic causes 3. Of all systemic factors, the use of anticoagulants and antiplatelet drugs appear to have a significant correlation with more severe and recurrent epistaxis 4. Antiplatelet medications specifically aspirin and clopidogrel are widely used in recent years for various forms of cardiovascular disease 3. There is no significant difference in risk of epistaxis in patients taking aspirin or clopidogrel 5. Epistaxis management in …show more content…
As an inclusion criterion we considered the bleeding of the referred patients with anterior epistaxis severe enough to need medical care (moderate severity). The patients were asked to compress both nostrils with two fingers for 20 minutes as the first aid measures if not encouraged to do that previously. Our exclusion criteria were: epistaxis following trauma, history of anticoagulant drug consumption, inherited bleeding disorders, hemophilia, inherited platelet disorders, INR > 1.5, Shock, visible bleeding vessel, history of renal disease, and lack of consent. Finally, patients consuming antiplatelet drugs, including aspirin, clopidogrel, or both during the acute phase of epistaxis with a new episode of anterior epistaxis or recurrent anterior epistaxis even with recurrent previous intervention entered in this study. Ethics review committee of our institute approved the study and it was registered at a clinical trial registry. Prior to entry to the trial, written informed consent was obtained from all …show more content…
In the aforementioned study, the proportion of patients with epistaxis treated with anterior nasal packing and bleeding stop time ≤10 min was approximately 30 percent7. We considered a minimum clinically important difference of 25% to make the topical use of injectable form of tranexamic acid preferable to the alternative, namely anterior nasal packing. Hence, we assumed if the new treatment could achieve 55% success (Δ =25%). A sample size of 57 per group was identified to achieve 80% power with a two-sided significance level of .05. We considered 10% of this figure to add to the calculated sample size to prevent the falling out during follow up, so final sample size was about 62 per
An initial dose of 300-600 mg clopidogrel should to be given along with the aspirin (NSW Health 2012). Nursing consideration: monitor for internal and external bleeding and allergies. Heparin: heparin prevents conversion of fibrinogen to fibrin and prothrombin to thrombin.
What were the results? Were they statistically significant (i.e., p0.20) What was the clinical importance of the results? Report the effect size if included in the study.
The following is a summary of a case review addressed in a meeting held on August 14, 2015. After reviewing several applications for licensure, Dr. Weschler, the
Nosebleeds are also called epistaxis. Learn all about nosebleeds, their causes and treatment from this site: URL/ImageCode11: http://www.medicinenet.com/nosebleed/article.htm Type11: DIY/ Helpful Advice PostText12: We also do minor aesthetic (cosmetic) procedures, such as chemical peels.
They were to report on patients’ side effects, patients use of the drug, and both patient and physician subjective evaluations. Physicians who were interested in participating in this research would be paid three hundred dollars for ever patient they entered into the study, as well as an additional three hundred for the patients who participated in a one year follow up evaluation. The payment in this case was considered compensation for physician’s time and effort.
So it was then that the NIH decided that any research that was to be funded had to be examined by a separate board to ensure informed consent was provided to the patients who participated in the
In the context of medical research, informed consent provides individuals with the opportunity to accept or decline involvement in research, and thereby adheres to their right to choose. Obtaining consent from donors is not limited to simply seeking permission, but involves explaining the nature and consequences of research in an honest and understandable manner. When this aspect of informed consent is ignored, unethical research ensues. For example, during the infamous Tuskegee Syphilis Experiments, US Public Health researchers studied the progression of syphilis in African American men, under the false pretense of curing their “bad blood”. Though a treatment of penicillin was available at the time, researchers idly observed as subjects died painful, preventable deaths.
In the study “Assessing the quality of informed consent in a resource-limited setting: A cross-sectional study,” researchers investigated the process of obtaining informed consent in clinical and public health research. The method of the study utilized interviews, in which research participants were asked a series of questions after they had been through informed consent procedures. 600 participants were interviewed, and the results show that 5.9% believed that they were not given enough information before deciding to participate. Only 5.7% of the participants said that they had not signed a consent form before making the decision to participate. Interestingly, 33.7% reported that they were not aware of their power to withdraw from participation
”(Skloot, 2010, p. 50). Racism has since been abolished and is now considered discrimination; also it is illegal to do any medical procedure on uninformed patients. However in today’s society like the era before, everyone has their own opinion and although it is legally and socially unethical people can still be bias. Also the patients in the studies did not have informed consent. There are three things in which you need to have informed consent; knowing, voluntary and competency.(10/17/13)
Fear can cause some patients to feel “ treated as mere "experimental model(s)" for the studies, while others refuse to take part because of historical evidences of clinical trial fraud and misconducts known to them” (Nijhawan 134). Preconceived patient perceptions lead patients to “believe that, trials will put extra burden on them. They assume that the conventional treatment is best and they are afraid of the unknown side-effects of new treatment. Convincing and receiving an informed consent from such patient is most difficult. In some case disclosing too much information of the potential side-effects may unnecessarily scare the patient away from a potentially life-saving or life-enhancing surgery or procedure”(Nijhawan 134).
For instance, the practitioners are obligated to constantly inform the participants about plans that pertains to interventions (Reamer, 1987). In addition, it is essential for informed consent to include the following: “What is done, the reasons for doing it, clients must be capable of providing consent, they must have the right to refuse or withdraw consent, and their decisions must be based on adequate information” (Kirk & Wakefield, 1997, p. 275). One of the most dehumanizing incidents that occur is the researchers prohibit the participants’ self-determination. For example, the men were compliant with receiving treatment and to be examined by the physicians.
Some questions do not lend themselves to clinical trials or research at all due to ethical limitations. EBP requires a question to be asked clearly, tools to help define a question such as the PICO tool may help (Hoffmann et al., 2013). While anyone can perform EBP, there is a limitation in that it does require training, experience and practice (Hoffman et al. 2013). Due to its’ relatively new arrival EBP training has not been accessible to all health professionals currently working.
This shows how even after a treatment was found, the doctors still refused treatment to most of the patients. In conclusion, the study was unethical and the doctors didn’t care about the health of their
This is known as the Institutional Review Board (IRB), which governs research ethics in studies involving human subjects in order to ensure no ethical violations would occur and the patients were protected. Unfortunately it took these 600 African-American men and their families to help create a review board in order to make sure patients rights in biological experiments such as this one are reviewed to confirm patient’s rights and ethical principals are being followed throughout human
1. Education to nursing staff who cared for Ms. Gadner on shock symptoms 2. Review with nurse Gilbert identification and treatment of infiltrated IV 3. Educate nursing staff who cared for Ms. Gadner on importance of documentation and updating of physicians of patient’s current condition. 4.